On August 29, CMS issued its final rule granting some healthcare providers “more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet Meaningful Use” (MU) during the 2014 reporting period. Prior to this final ruling, CMS considered feedback from healthcare providers, EHR vendors, and other stakeholders in response to its May 23 Notice of Proposed Rulemaking (NPRM), or proposed rule, on 2014 MU flexibility.
NextGen Healthcare welcomes the final rule as it provides relief for some providers struggling with technology issues and new workflow requirements. Prior to issuing its proposed rule in May, CMS had acknowledged that MU attestations across the industry for the 2014 reporting year were extremely low. This remains the case; fewer than two percent of those providers who previously attested have attested for MU in 2014.*
*Based on latest Medicare MU attestation data from CMS
This article is not intended to provide legal or regulatory advice, but is for information purposes only. NextGen Healthcare strongly recommends that the reader seek advice from their own counsel or third-party expert to obtain guidance on the subject matter of this document.
What does the Final Rule say?
The final rule establishes a set of options for providers at Stage 1 and Stage 2 who have been unable to fully implement 2014 Edition CEHRT due to delays in availability of needed technology. CMS notes that these delays may be due to certification delays, upgrade backlogs, frequent updates, a negative effect on productivity, and the need for “software patches and workflow changes.”
The final rule also states that a “provider’s ability to fully implement all of the functionality of 2014 Edition CEHRT may be limited by the availability and timing of product installation, deployment of new processes and workflows, and employee training.”
To leverage the flexibility offered by the final rule, providers will need to attest that they could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability. The options for providers who meet this criterion are as follows:
- Providers using 2011 Edition CEHRT can meet and attest for 2013 Stage 1 objectives and measures, regardless of which Stage they were scheduled to meet;
- Providers using 2014 Edition CEHRT can meet and attest for:
- 2014 Stage 1 objectives and measures if they were scheduled to meet Stage 1
- 2014 Stage 1 or Stage 2 objectives and measures if they were scheduled to meet Stage 2 requirements
The rule also permits Stage 1 providers to use a combination of 2011 Edition and 2014 Edition CEHRT to meet 2013 Stage 1 objectives and measures or 2014 Stage 1 objectives and measures; Stage 2 providers have the same choice, along with the option to meet and attest for Stage 2 as scheduled.
Providers may select any of the previous quarters this year for their attestation so long as they have completed their security risk analysis prior to the end of that quarter. The final submission of attestations for 2014 must be completed by the end of February, 2015.
What does this mean for NextGen Healthcare clients?
Based on our analysis, NextGen Healthcare believes the final rule gives flexibility to clients still working to fully implement our 2014 Edition CEHRT, adopt new workflows, and manage upgrade issues. We encourage each client to review the final rule and consult with their advisors and legal counsel prior to making the decision that best supports the goals of their organization and to confirm applicability of the regulations.
Clients deciding to leverage the rule’s flexibility will need to keep documentation in support of their reasons for failing to meet their scheduled 2014 attestation requirements. For those who have elected to delay based on the frequent NextGen® Knowledge Base Model (NextGen KBM) updates released monthly earlier in the year, we will make available a letter detailing the dates of these releases to keep in support of your audit documentation.
Flexible support options for Meaningful Use 2014
- a) MU 2014 Standalone Templates
If you have experienced difficulty using our NextGen® KBM 8.3 series platform to meet MU requirements, NextGen Healthcare will be releasing a set of MU 2014 Standalone Templates** for Stage 1 (2014) and Stage 2 objectives (we offered a similar standalone template solution for Stage 1 MU compliance in previous years). We expect to have these templates available for clients prior to October 1, 2014, which is the start of the final 2014 MU reporting period.
While our MU 2014 Standalone Templates are intended to help clients bridge and meet MU 2014 reporting requirements, this solution should be undertaken with an understanding of the design limitations of the standalone templates.
- As the word “standalone” implies, these templates are not integrated into the client’s existing NextGen® KBM workflow and require that EPs “step outside” their standard workflow and enter data directly into the standalone templates
- This ensures that the proper data is being collected and that the data are available for reporting purposes
- Not all quality measures are available using these templates
- Cancer case registry reporting and use of NextGen® Share are not supported by these templates
- Clients will need to determine whether our MU 2014 Standalone Templates will meet their attestation needs
** MU 2014 Standalone Templates require users to be on version 5.8 or 5.8 UD1 of NextGen® Ambulatory EHR
- b) NextGen KBM Version 8.3.x to meet 2014 Stage 1 and Stage 2 objectives and measures
- NextGen KBM 8.3.8 should be your targeted NextGen KBM destination in advance of October 1, 2014, which is the beginning of the final reporting period.
- NextGen KBM 8.3.8 supports ICD-10 and the 2014 MU requirements for Stage 1 and Stage 2
- All 64 clinical quality measures (CQMs) included in Meaningful Use Stage 2 are supported by NextGen KBM 8.3.8
- NextGen KBM 8.3.8 incorporates all previous 8.3 series updates – 8.3.1 through 8.3.7.
- NextGen KBM 8.3.8 has undergone significant additional testing and evaluation focused on MU documentation and patient safety. We will be providing hot fixes for identified critical defects. NextGen KBM 8.3.8 will be the last update for the next several months so that we can provide the support necessary for clients to start, continue, or finish their upgrade directly to NextGen KBM 8.3.8
Meeting MU and ICD-10 requirements in 2015
Clients should understand that the Final Rule does not change the requirement to use 2014 Edition CEHRT to meet a full year of MU in 2015. To meet the full-year requirement, clients need to fully implement the 2014 Edition certified software version (5.8 or 5.8 UD1) prior to January 1, 2015. In addition, implementation of a patient portal must be done prior to January 1, 2015.
NextGen KBM 8.3 series is our integrated out-of-the-box clinical content solution for both MU 2014 requirements and ICD-10. As clients work toward their 8.3 series upgrade, they will have the option to continue using the MU 2014 Standalone Templates during the 2015 reporting year before transitioning to the NextGen KBM 8.3 series. All clients must be on NextGen KBM 8.3 or higher prior to October 1, 2015 for ICD-10 support.
NextGen KBM Version 8.3.10 to meet 2014 Stage 1 and Stage 2 objectives and measures in 2015
NextGen KBM 8.3.10 is not yet available; when it is, it will contain some usability refinements requested by the client base as well as selected performance enhancements. Additionally, this release will contain enhancements designed to address workflow issues for a number of specialty content areas including Cardiology, Dermatology, Ophthalmology, Orthopedics, GI, and Primary Care. We recommend that clients who are not part of the above listed specialty groups NOT wait for the release of NextGen KBM 8.3.10. Upgrading now to NextGen KBM 8.3.8 will lessen workflow and productivity disruption during the NextGen KBM 8.3.10 upgrade – whenever that upgrade enters general release.
We are committed to helping every NextGen Healthcare client upgrade to the latest available NextGen KBM version as quickly and smoothly as possible. We’ll work with you every step of the way.
Helpful resources
The NextGen Healthcare Customer Support telephone number is 215-657-4373. Additional guidance and information is available from the Client Resources tab on our website. We’ll also issue NextGen KBM 8.3.8 upgrade information on a regular basis to keep clients informed and focused on this important software upgrade goal.
MU 2014 Flexibility Rule on MU page on Knowledge Exchange.
In addition, CMS has posted a 2014 CEHRT Rule Quick Guide with information and links to other CMS resources to help providers understand the final rule.